Two days after Algerian President Abdelaziz Bouteflika was airlifted to a military hospital in Paris to be treated for a supposed “mini-stroke,” his doctors raced to reassure the country that the autocratic ruler was not seriously ill and, indeed, would soon be home — a message that seemed designed to ward off any maneuvers by his rivals to oust him during his absence. “The President is in very good health,” his doctor Rachid Bougherbal was quoted as saying in the government-aligned Ennahar newspaper on Monday, adding that the President would return to Algiers “in not more than seven days.”

Still, the doctor’s message did little to tamp down furious speculation among Algerians. Bouteflika had barely left the country when politicians and analysts began debating whether his 14-year rule was finally over, or at least how much longer he was capable of governing the oil-rich North African country, which has by far the region’s biggest military, and which has faced a long-standing Islamist insurgency. Algerian newspapers were filled on Monday with heated discussion over the country’s future. With the government notoriously secret, Algerians have grown accustomed to picking apart official statements and looking for clues about the true state of affairs. “There is something new this time, in that the announcement of the President’s illness was made by the presidency,” political analyst Rashid Grim told the Algerian newspaper al-Watan; previous bouts of illness went unexplained to the public. “This means he is sick but that his life is not in danger.” Grim also said he believed the regime had already chosen someone to step into power in case Bouteflika were incapacitated.

Bouteflika came to power after Algeria’s devastating civil war against Islamist fighters, which is believed to have killed up to 200,000 people, on the promise of cracking down hard on militants, and keeping Algeria safe from insurgency — to a large extent, at the expense of open democracy. For Western leaders, Bouteflika’s departure, if it happened, could entail a tough adjustment, especially since the Arab Spring ousted longtime allies in Egypt’s Hosni Mubarak and Tunisia’s Zine el-Abidine Ben Ali.

After the 9/11 attacks, Bouteflika signed an intelligence-sharing relationship with the U.S. Bouteflika refused to join the NATO-led campaign against Muammar Gaddafi in next-door Libya in 2011, and refused to send Algerian troops to join the French-led offensive in northern Mali in January. Yet when Islamist militants seized the In Amenas gas plant in southeastern Algeria in January, killing dozens of foreign oil workers, Bouteflika allowed U.S. surveillance drones to hover overhead throughout the siege. “Algiers has been feted by Paris and Washington in the hopes of enlisting Algeria’s help in stabilizing northern Mali and performing a broader regional counterterrorism role,” says Geoff Porter, director of North Africa Risk Consulting Inc. in Washington. “If the presidency is prematurely up for grabs, Algeria would turn acutely inward. France and the U.S. would find themselves without reliable interlocutors.”

Algerians have good reason to question the statement from Bouteflika’s doctor about the President’s health. In 2005 and again in 2006, Bouteflika was flown to the same French military hospital in Paris, for what his doctors said was treatment for a hemorrhagic stomach ulcer. A year later, Bouteflika admitted that he had been “very, very ill.” But it took a few years more before Algerians learned that their President had in fact undergone treatment for cancer — and even then, they were not told by their own government. The truth emerged only in 2011, when WikiLeaks published a U.S. diplomatic cable in which then ambassador Robert Ford wrote in 2007 that a doctor close to Bouteflika had “told us in strictest confidence that the President suffered from cancer.” That was news to Algerians.

This time, Bouteflika, 76, has taken ill at an intensely awkward time. For months, top officials in the regime have squabbled bitterly over who might ultimately succeed Bouteflika — a subject that until recently seemed almost unmentionable. Under constitutional reforms that are currently under way, Algeria is set to appoint a Deputy President for the first time, a move aimed at paving the way for succession, after years in which Bouteflika has ruled the country with unchallenged authority.

Despite his frail health, Bouteflika has made it clear he intends to stand for a fourth term in office. That would all but ensure his victory, since the controlled process weeds out serious threats to his leadership. “The intelligence services are trying to make sure that the succession process goes their way,” says Riccardo Fabiani, North Africa analyst for the Eurasia Group in London. Given the fact that Bouteflika’s successor could rule for more than a decade, who comes next is crucial for Algeria. Despite its mammoth oil and gas reserves, the country faces declining production and high youth unemployment — both factors that could potentially spark an Arab Spring–style revolt. “There is no long-term perspective about when Algeria’s oil runs out,” Fabiani told TIME on Monday. That could happen, he says, “realistically between 10 and 20 years’ time.”

For most Algerians, the political crisis has arrived far sooner. With Bouteflika out of sight, the tone in the country’s media was impatient, and even irreverent, given the President’s fragile state. The Oran Daily, a newspaper in Algeria’s industrial city, said on Monday that it was unclear whether Bouteflika could last as President even until next year’s election, and warned that Algeria risked all-out revolt by keeping its ruler too long, as Libyans did with Gaddafi and Syrians with Bashar Assad. “We are dangerously infected with the syndrome of Gaddafi or Bashar,” the paper’s editorial said. In a more irreverent tone, a cartoonist in al-Watan showed Bouteflika’s medical team addressing a press conference, and announcing in unison: “The President will need to maintain total rest during his fourth term in office.”